The recent South Dakota Public Transit Research Project report paints a picture of the crucial role that transit plays in rural areas. "In the absence of public transit, many of them would have no choice but to forego their trips. This implies that some people would lose their job and apply for public assistance, or require home care, or move to a nursing home facility." The report concludes that for every dollar spent on public transit, the state generates $1.90 in economic activity, or almost double the return on investment.

Though the report finds a connection to the recession, with an increase in ridership since 2008,rural transit is largely transportation to medical care.

[T]he more rural the service area and the larger the share of benefits attributed to medical trips. For instance, benefits attributed to medical trips represent 73 percent of total benefits for Rural systems whereas they account for just 38 percent of total benefits for Urbanized systems. This difference can be explained by two factors: the share of medical trips is typically higher for rural transit providers than for urban transit providers ...; congestion related benefits (travel time savings and emissions cost savings in particular) are non‐existent (or slightly negative in some cases) in rural settings.

Another consequence of the recession is that rural transit systems are experiencing “load shifting”, in other words an increase in ridership as a result of transportation service cuts from human service agencies.

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